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Primary objectives were to examine: (1) changes in movement behaviours (i.e., outdoor play (OP), organized physical activity (PA), screen time (ST), sleep) across the first 2 years of coronavirus disease-2019 (COVID-19) among Canadian toddlers and preschoolers, and (2) intrapersonal, interpersonal, community, and policy moderators of change in movement behaviors. Participants were 341 Canadian parents of children (start of study: 1-4 years; 48% female). Participants completed online questionnaires regarding their children's movement behaviours and intrapersonal, interpersonal, and community factors at five time-points before and throughout the pandemic (T1-T5). Data from government websites were also used for some community and policy factors. Linear mixed models were conducted. Compared to pre-COVID-19 (T1): OP was on average 30 min/day higher at T2 and T3; organized PA was on average 62, 44, and 37 min/day lower at T2, T3, and T4, respectively; ST was on average 67, 17, 38, and 52 min/day higher at T2, T3, T4, and T5, respectively; and sleep was on average 30, 36, and 82 min/day lower at T3, T4, and T5, respectively. Significant moderating variables were observed for OP (parental education, parental work inside home, COVID-19 restriction severity), organized PA (children's sex, started kindergarten, nonparental care, parental education, household income, parental employment status, house type, indoor home space and support for PA), ST (nonparental care, parental marital status) and sleep (children's T1 age group, started kindergarten, parental place of birth, parental employment status). All movement behaviors changed across the first 2 years of COVID-19 but patterns and moderators were behaviour-specific. Children from lower socioeconomic status families had the least optimal patterns.
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COVID-19 , Ejercicio Físico , Tiempo de Pantalla , Sueño , Humanos , COVID-19/epidemiología , Femenino , Masculino , Preescolar , Canadá/epidemiología , Lactante , Juego e Implementos de Juego , Conducta Infantil , Encuestas y Cuestionarios , Padres/psicología , Conducta Sedentaria , SARS-CoV-2 , Pandemias , Factores Socioeconómicos , AdultoRESUMEN
Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally classified as an overuse injury associated with fusiform tendon thickening, neovascularization, and interstitial tendon degeneration. Current literature suggests these structural changes are associated with symptoms and lower physical activity levels, as well as symptoms and lower extremity function in the long term. Surgically and non-surgically managed Achilles tendon ruptures result in increased tendon cross-sectional area (CSA) and a lengthened Achilles tendon. Both structural outcomes have clinical implications, as larger CSA positively predicts function, whereas increased tendon lengthening predicts reduced function after Achilles tendon rupture. Given the relationship between structural changes associated with Achilles tendon injuries for both injury severity and injury recovery, it is critical to be able to quantify Achilles tendon structure reliably and accurately. Silbernagel's group has established a valid and reliable method for efficiently evaluating triceps surae muscle and tendon structure. In this protocol, B-mode musculoskeletal ultrasound imaging is used to measure triceps surae structure, including Achilles tendon thickness and CSA, soleus thickness, and the presence of additional findings (calcifications and bursitis). B-mode extended field-of-view is used to measure Achilles tendon length and gastrocnemius anatomical CSA. Finally, power Doppler is used to identify intratendinous neovascularization. Quantification of triceps surae structure allows for comparison between limbs as well as longitudinal changes in response to exercise and treatment for healthy individuals and those with Achilles tendon injuries. This protocol has been used in many research studies to date and proves valuable in understanding the relationship between tendon structure and injury development, severity, and recovery. As ultrasound devices are becoming more affordable and portable, this protocol proves promising as a clinical tool, given its quick and efficient methods.
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Tendón Calcáneo , Tendinopatía , Traumatismos de los Tendones , Humanos , Tendón Calcáneo/diagnóstico por imagen , Calidad de Vida , Músculo Esquelético/diagnóstico por imagenRESUMEN
We examined perceived risk of future sports injury and athlete burnout among uninjured adolescent athletes. Uninjured high school athlete participants completed the Athlete Burnout Questionnaire (ABQ) and a questionnaire assessing attitudes toward likelihood of sustaining a future sport-related injury. We compared ABQ responses between injury risk perception groups: those who expected injury versus those who did not. Half of the participants reported a somewhat/very high likelihood of future sport-related injury (n = 98; 52% female; age = 15.3 ± 1.9 years), while the other half reported it was unlikely/not possible (n = 98; 45% female; age = 15.3 ± 1.3 years). A significantly greater proportion of those in the expected injury group reported a history of bone/muscle/ligament/tendon injury (56% vs 24%; P < .001). Those in the expected injury group reported higher athlete burnout scores (median = 28 [interquartile range = 25-34] vs 25 [23-30]; P = .002). Adolescent athletes who reported they were likely to experience a future injury in their sport also reported greater levels of burnout.
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Traumatismos en Atletas , Agotamiento Profesional , Deportes , Humanos , Adolescente , Femenino , Masculino , Atletas , Traumatismos en Atletas/epidemiología , Factores de Riesgo , Agotamiento Profesional/epidemiologíaRESUMEN
CONTEXT: Sever's disease (calcaneal apophysitis) is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's disease wear heel cups in their shoes while active, but barefoot athletes are unable to use heel cups. OBJECTIVE: To compare the efficacy of 2 braces used by barefoot athletes with Sever's disease. DESIGN: Randomized controlled clinical trial. SETTING: Pediatric sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 43 barefoot athletes aged 7 to 14 years were enrolled, and 32 completed the study (age = 10.3 ± 1.6 years; 29 girls, 3 boys). INTERVENTION(S): Participants were randomized to the Tuli's Cheetah heel cup (n = 16) or Tuli's The X Brace (n = 16) group for use during barefoot sports over the 3-month study period. MAIN OUTCOME MEASURE(S): Participants completed self-reported assessments after diagnosis (baseline) and 1, 2, and 3 months later. The primary outcome was the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3 months postenrollment). The secondary outcomes were OxAFQ-C school or play and emotional scores and the visual analog scale pain score. RESULTS: The percentage of time wearing the brace during barefoot sports was not different between the Cheetah heel cup and The X Brace groups (82% versus 64% of the time in sports; P = .08). At 3 months, we observed no differences for the OxAFQ-C physical (0.79 versus 0.71; P = .80; Hedges g = 0.06), school or play (0.94 versus 1.00; P = .58; Hedges g = 0.26), or emotional (1.00 versus 1.00; P = .85; Hedges g = 0.21) score. Visual analog scale pain scores during activities of daily living and sports were lower (better) at the 2- and 3-month time points than at baseline (P < .001). CONCLUSIONS: Both groups demonstrated improvements in ankle and foot function across time, but no between-groups differences were seen at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.
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Atletas , Calcáneo , Adolescente , Niño , Femenino , Humanos , Masculino , Actividades Cotidianas , DolorRESUMEN
INTRODUCTION: The PLAYshop programme is a novel, brief, theory-based, parent-focused physical literacy intervention in early childhood designed to address the major public health issue of childhood physical inactivity. The primary objective of this study is to examine the efficacy of the virtually delivered PLAYshop programme in increasing preschool-aged children's physical literacy, including fundamental movement skills and motivation and enjoyment. METHODS AND ANALYSIS: This study aims to recruit 130 families with preschool-aged children (3-5 years) from Alberta and British Columbia, Canada who will be randomised to an intervention or control group. The PLAYshop programme is informed by the Capability, Opportunity, Motivation, Behavior (COM-B) model and includes four intervention strategies: (1) educational training via a 60 min virtual synchronous workshop, (2) educational resources via handouts, (3) material resources via a goody bag of basic active play equipment and (4) follow-up support via access to a digital app with an online toolkit and four biweekly booster lessons (1-week, 3-week, 5-week and 7-week follow-up). To assess the primary outcome of physical literacy, five fundamental movement skills (overhand throw, underhand throw, horizontal jump, hop, one leg balance) will be measured virtually at baseline and 2-month follow-up using the Test of Gross Motor Development (TGMD) and the Movement Assessment Battery for Children-Second Edition (MABC-2) tools. Additionally, children's motivation and enjoyment will also be assessed at baseline and 2-month follow-up by: (1) parental-report using items from the Preschool Physical Literacy Assessment (PrePLAy) and (2) self-report using an adapted Five Degrees of Happiness Likert scale for children. The control group will receive the PLAYshop programme after the 2-month follow-up. ETHICS AND DISSEMINATION: The protocol was approved by the University of Alberta (00093764) and University of Victoria (16-444) Research Ethics Boards. Findings will be disseminated through peer-reviewed publications, conference presentations, social and traditional media and a circulated infographic. TRIAL REGISTRATION NUMBER: NCT05255250.
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Alfabetización , Padres , Humanos , Preescolar , Padres/educación , Instituciones Académicas , Motivación , Alberta , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
AIM: The Cass Clinic is a student-run free clinic in Detroit, Michigan that treats chronic diseases including hypertension (HTN), diabetes mellitus (DM), and obesity. Our study aims to quantify the effectiveness of our clinic in managing chronic diseases. SUBJECT AND METHODS: This study assessed selected health outcomes for 137 patients who visited our clinic between September 1, 2017 and August 31, 2018 based on initial and most recent surrogate markers including manual blood pressure, hemoglobin A1c (HbA1c), and body mass index (BMI) recorded in the clinic's medical record system dating back to 2012. RESULTS: Patients were divided into two groups: occasionally seen patients (OSP) and frequently seen patients (FSP). FSP with HTN had systolic blood pressure (SBP) decreased by an average of 14.1 mmHg and diastolic blood pressure (DBP) decreased by 9.8 mmHg, which were statistically associated with the number of clinic visits. Additionally, all patients treated at Cass Clinic saw a decrease in their HbA1c and BMI. HbA1c in OSP decreased by 0.50%. HbA1c in the FSP decreased by 1.7%. Patients with at least two recorded BMIs (n=73) saw a decrease of 0.13 kg/m2. CONCLUSION: The data from our analysis support that a student-run free clinic model like Cass Clinic provides long-term value for patients who frequently utilize the clinic. These clinics also act as an important resource for the community by making positive strides toward better health in multiple measurable outcomes, including HTN and DM management.
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PURPOSE: To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. METHODS: Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. RESULTS: We included 109 children 8-12 years of age (24% female, evaluated medianâ=â7 [interquartile rangeâ=â4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated medianâ=â7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; pâ<â0.001). They also made more BESS errors in single (medianâ=â5 [2-10] vs. 4 [2-6] errors) and tandem (medianâ=â3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratioâ=â3.05, 95% CIâ=â1.68-5.53) and more firm surface BESS errors (double stance ß=0.51, 95% CIâ=â0.22-0.80; single stance ß=â1.18, 95% CIâ=â0.42-1.95; tandem stance ß=â0.98, 95% CIâ=â0.28-1.68) than adolescents. CONCLUSIONS: Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.
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Conmoción Encefálica , Equilibrio Postural , Adolescente , Conmoción Encefálica/complicaciones , Niño , Preescolar , Femenino , Marcha , Humanos , MasculinoRESUMEN
Objective: Pediatric primary care sports medicine physicians and pediatric sports medicine orthopedic surgeons, in conjunction with physician assistants (PAs), often manage patients with fractures. We sought to determine if pediatric patients with fractures seen by primary care sports medicine physicians had similar outcomes and satisfaction as those seen by orthopedic surgeons. Methods: We performed a retrospective chart review of four to 18-year-old patients who were treated by a sports medicine provider (primary care or orthopedic surgeon/PA) for a fracture of the radius, ulna, tibia, or fibula. Patients or their parents completed a patient satisfaction survey (Short Assessment of Patient Satisfaction [SAPS]) and an injury location-specific patient-reported functional outcome tool: the Foot and Ankle Ability Measure (FAAM) or the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale. Results: Fifty-seven (70%) of the 82 patients were treated by pediatric primary care sports medicine physicians and 25 (30%) were treated by a pediatric sports medicine orthopedic surgeon or surgical PA. The median time from injury to clinically confirmed healing was similar between the two groups (47 vs 60.5 days; p = 0.54), as was the patient satisfaction (SAPS median score = 26 [range = 19-28] vs 24 [range = 9-28]; p = 0.12). Patient-reported outcomes did not differ significantly between groups for the functional outcome tools. Conclusions: Patients seen by pediatric primary care sports medicine physicians and sports medicine orthopedic surgeons have similar patient-reported fracture outcomes and similar satisfaction with care. Pediatric patients with fractures will likely have favorable outcomes when cared for by either of these subspecialty providers.
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Fracturas Óseas/terapia , Cirujanos Ortopédicos , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Médicos de Atención Primaria , Deportes Juveniles/lesiones , Adolescente , Niño , Preescolar , Curación de Fractura , Encuestas de Atención de la Salud , Humanos , Estudios Retrospectivos , Medicina DeportivaRESUMEN
OBJECTIVES: To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems. DESIGN: Longitudinal test-retest. SETTING: Sports medicine clinic. PARTICIPANTS: Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury. INDEPENDENT VARIABLES: We grouped patients based on whether they reported sleep disturbances within 14 days of injury. MAIN OUTCOME MEASURES: Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits. RESULTS: Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80). CONCLUSIONS: Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery.
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Traumatismos en Atletas , Conmoción Encefálica , Melatonina , Síndrome Posconmocional , Trastornos del Sueño-Vigilia , Adolescente , Atletas , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/tratamiento farmacológico , Conmoción Encefálica/complicaciones , Conmoción Encefálica/tratamiento farmacológico , Niño , Femenino , Humanos , Masculino , Melatonina/uso terapéutico , Síndrome Posconmocional/tratamiento farmacológico , Prescripciones , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos del Sueño-Vigilia/etiologíaRESUMEN
OBJECTIVE: The objective of the study was to evaluate the clinical outcomes among patients who did and did not report engaging in early physical activity (PA) following sport-related concussion. METHODS: We evaluated pediatric patients seen within 21 days of concussion. The independent variable was early PA engagement (since the injury and before initial clinical evaluation). Dependent variables included demographics, injury details, medical history, Health and Behavior Inventory (HBI) score, and balance, vestibular, and oculomotor function tests. RESULTS: We examined data from 575 pediatric patients: Sixty-nine (12%) reported engaging in early PA (mean age=14.3±2.4 years; 30% female). The no PA group (mean age=14.5±2.4 years; 35% female) had significantly longer symptom resolution times than the early PA group (median= 16 [interquartile range (IQR)=8-24] vs. 10.5 [IQR=4-17] days; p=0.02). When controlling for pre-existing headache history and time from injury-evaluation time, the early PA group demonstrated lower odds of reporting current headache (adjusted odds ratio=0.14; 95% CI=0.07, 0.26), and reported lower symptom frequency ratings than the no PA group (b=-5.58, 95% CI=-8.94, -2.22). CONCLUSIONS: Patients who did not engage in early PA had longer symptom duration, greater odds of post-injury headache, and greater symptoms at initial clinical evaluation. We cannot determine if patients engaged in early PA due to the lower symptom burden and higher functioning at the time of assessment, or if early PA positively affected outcomes. However, as early PA was associated with better post-injury outcomes, clinicians may consider supervised and structured early PA programs as a method to improve clinical outcomes following concussion. RELEVANCE FOR PATIENTS: Children and adolescents who were engaged in PA after concussion presented to a clinic with less severe symptoms and had symptoms that resolved sooner compared to those who did not engage in early PA after concussion.
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BACKGROUND: Female gymnasts have a greater prevalence of back pain compared to other female athletes. There is little evidence that female artistic gymnasts with and without back pain demonstrate different movement patterns during gymnastics skills. The purpose of this study was to determine if there were differences in back movements during back walkovers and back handsprings among female artistic gymnasts. METHODS: Female artistic gymnasts (8-18 years old) with and without back pain wore inertial sensors on their torso, arms, and legs while performing back walkovers (N = 14) and back handsprings (N = 15) on the floor and balance beam at their training gymnastics facilities. FINDINGS: Gymnasts with back pain had similar spine peak extension, peak flexion, and range of motion during back walkovers and back handsprings compared to gymnasts without back pain. Additionally, no differences in sagittal plane spine kinematics were found between the groups at any specific time point during either the back walkover or back handspring skills. However, a large portion of the data collected was excluded during quality assurance, thus our final sample sizes are small. INTERPRETATION: These findings suggest that gymnasts with back pain have similar sagittal plane movements to those without back pain. The relationship between back pain and gymnastics training load/intensity is currently unclear. We suggest future studies to investigate common artistic gymnastics skills and back pain prevalence with more participants, full-body motion analysis with kinetic measurement capabilities, and longitudinally for those demonstrating back pain.
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Atletas , Gimnasia , Dolor de la Región Lumbar/fisiopatología , Fenómenos Mecánicos , Columna Vertebral/fisiología , Columna Vertebral/fisiopatología , Adolescente , Adulto , Fenómenos Biomecánicos , Niño , Femenino , Humanos , MovimientoRESUMEN
OBJECTIVES: The purpose of our investigation was to compare post-concussion symptom profiles and postural control measures among female youth artistic athletes (gymnasts and cheerleaders) relative to female ball sport athletes (volleyball or basketball). METHODS/FINDINGS: We compared 27 artistic athletes (median age = 15.0 years; evaluated median = 13 days post-injury) and 49 ball sport athletes (median age = 15.3 years; evaluated median = 10 days post-injury) within 21 days of sustaining a concussion on measures of symptom profiles and postural control (Balance Error Scoring System [BESS]), tandem gait, and Romberg tests. After adjusting for the independent effect of time from injury-evaluation, concussion history, and pre-morbid migraine history, we observed that artistic athletes performed the BESS tandem stance foam condition with fewer errors than ball sport athletes (ß = -2.4; 95% CI = -4.7, -0.2; p = .03). Artistic athletes demonstrated a higher, yet not statistically significant, headache severity than ball sport athletes (median = 4.5 vs 4.0, p = .07). CONCLUSIONS: Overall, artistic athletes had similar symptom profiles to ball sport athletes. Postural control measures, other than the BESS tandem stance foam condition, were not significantly different from ball sport athletes. This suggests that although their sports may require higher levels of balance, artistic athletes' performance on post-concussion balance tests may be similar to athletes of other disciplines.
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Traumatismos en Atletas , Conmoción Encefálica , Síndrome Posconmocional , Adolescente , Atletas , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/epidemiología , Conmoción Encefálica/epidemiología , Femenino , Humanos , Recién Nacido , Síndrome Posconmocional/diagnóstico , Síndrome Posconmocional/epidemiología , Síndrome Posconmocional/etiología , Equilibrio PosturalRESUMEN
Our objective was to examine the effect of current neck or shoulder pain on concussion outcomes. Variables included symptom resolution and return-to-sport time, symptom severity, amount of school missed, and sleep disturbances. Three hundred twelve patients (37% female; median age = 15.0 years; evaluated median = 9 days postinjury) reported experiencing current neck or shoulder pain at initial evaluation, and 268 did not (31% female; median age = 14.7 years; evaluated median = 8 days postinjury). Neck or shoulder pain was associated with longer symptom resolution time (ß = 6.38, 95% confidence interval [CI] = 2.44, 10.31; P = .002), more severe symptoms (ß = 7.06, 95% CI = 4.91, 9.21; P < .001), and greater odds of missing >5 days of school (adjusted odds ratio [aOR] = 1.89, 95% CI = 1.23, 2.93; P = .004), and postinjury sleep problems (aOR = 2.20, 95% CI = 1.51, 3.21; P < .001). Experiencing neck or shoulder pain during the initial postinjury clinical evaluation was associated with worsened clinical outcomes. Clinicians may consider referral to early rehabilitation following concussion among those who report neck or shoulder pain.
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Traumatismos en Atletas/complicaciones , Conmoción Encefálica/complicaciones , Dolor de Cuello/complicaciones , Volver al Deporte/estadística & datos numéricos , Dolor de Hombro/complicaciones , Adolescente , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
CONTEXT: Understanding how parents and their children perceive concussion symptoms may provide insights into optimal concussion-management strategies. OBJECTIVE: To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time. DESIGN: Cross-sectional study. SETTING: Primary care sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 267 patients aged 8 to 18 years seen for care within 21 days of sustaining a concussion. Patients were classified as children (n = 65; age = 11.3 ± 1.4 years; age range, 8-12 years) or adolescents (n = 202; age = 15.5 ± 1.4 years; age range, 13-18 years). MAIN OUTCOME MEASURE(S): Each patient and his or her parent (or legal guardian) completed a concussion-symptom-frequency inventory, the Health and Behavior Inventory (HBI), at the initial postinjury examination. Patients were followed until they no longer reported concussion symptoms (symptom-resolution time) and were allowed to return to unrestricted sport participation (return-to-play time). RESULTS: At the initial examination (8.9 ± 5.2 days postinjury), the symptom-frequency correlation between children and their parents was high (rs = 0.88; 95% confidence interval [CI] = 0.80, 0.95). Adolescents' symptom-frequency reports were also highly correlated with those of their parents (rs = 0.78; 95% CI = 0.71, 0.85). However, the child-parent correlation was higher than the adolescent-parent agreement (z = 2.21, P = .03). Greater patient (consolidated child and adolescent) HBI ratings were associated with longer symptom-resolution times (coefficient = 0.019; 95% CI = 0.007, 0.031; P = .002) and longer return-to-play times (coefficient = 0.012; 95% CI = 0.002, 0.022; P = .02), whereas parent HBI ratings were not. CONCLUSIONS: Our findings may help to set expectations regarding concussion-symptom durations and return-to-play timing for pediatric patients and their families. Given the patient-parent correlations in our sample, substantial reporting discrepancies between patients and their parents may be a relevant factor for clinicians to investigate further during concussion evaluations.
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Traumatismos en Atletas/diagnóstico , Conmoción Encefálica/diagnóstico , Conductas Relacionadas con la Salud , Padres , Medicina Deportiva/métodos , Adolescente , Adulto , Traumatismos en Atletas/complicaciones , Conmoción Encefálica/etiología , Niño , Estudios Transversales , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To examine differences between male and female adolescents on measures of balance, vestibular and oculomotor function within 3 weeks of concussion among a group of pediatric patients presenting to a sports medicine clinic. DESIGN: Medical record review. SETTING: Sports medicine clinic. PARTICIPANTS: 197 female (median age = 15.2 years) and 381 male (median age = 14.6 years) pediatric patients seen for a concussion, evaluated 9.3 ± 5.2 (mean ± SD) days post-concussion. MAIN OUTCOME MEASURES: Patients completed Balance Error Scoring System (BESS), tandem gait, gaze stability, and near point of convergence (NPC) tests. RESULTS: A higher proportion of female patients exhibited abnormal NPC (22% vs. 14%; p = 0.017), gaze stability (53% vs. 43%; p = 0.028), and tandem gait tests (20% vs. 13%; p = 0.026) compared to male patients. Multivariable analysis indicated an independent association between female sex and increased odds of abnormal NPC (adjusted odds ratio [aOR] = 1.79, 95% CI = 1.07-3.00), and tandem gait tests (aOR = 1.96, 95% CI = 1.12-3.41) following concussion. CONCLUSIONS: Our results indicate that within the first three weeks of a concussion, female pediatric patients demonstrated increased odds of exhibiting abnormal near point of convergence, and tandem gait test performance compared to male patients.
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Traumatismos en Atletas/fisiopatología , Conmoción Encefálica/fisiopatología , Movimientos Oculares/fisiología , Músculos Oculomotores/fisiopatología , Equilibrio Postural/fisiología , Enfermedades Vestibulares/fisiopatología , Vestíbulo del Laberinto/fisiopatología , Adolescente , Traumatismos en Atletas/complicaciones , Conmoción Encefálica/complicaciones , Femenino , Marcha/fisiología , Humanos , Masculino , Enfermedades Vestibulares/etiología , Pruebas de Función VestibularRESUMEN
We examined the association between sleep quality and quality of life (QOL) among uninjured high school athletes. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 questionnaire. One hundred ten athletes reported poor sleep quality (mean PSQI: 6.6 ± 2.0; mean age: 15.3 ± 1.1; 62% female); 162 athletes reported good sleep quality (mean PSQI: 2.3 ± 1.3; mean age: 15.1 ± 1.7; 33% female). After adjusting for sex and age, worse sleep quality was associated with higher physical function/mobility (ß = 0.034; 95% confidence interval [CI] = 0.007-0.060; P = .01), anxiety (ß= 0.391; 95% CI = 0.263-0.520; P < .001), depressive symptom (ß = 0.456; 95% CI = 0.346-0.565; P < .001), fatigue (ß = 0.537; 95% CI = 0.438-0.636; P < .001), pain interference (ß = 0.247; 95% CI = 0.119-0.375; P < .001), and pain intensity (ß = 0.103; 95% CI = 0.029-0.177; P = .006) ratings. Poor self-reported sleep quality among adolescent athletes was associated with worse QOL ratings. Clinicians should consider assessing sleep hygiene to provide guidance on issues pertaining to reduced QOL.
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Ansiedad/psicología , Atletas/psicología , Estado de Salud , Calidad de Vida/psicología , Trastornos del Sueño-Vigilia/psicología , Adolescente , Ansiedad/complicaciones , Femenino , Humanos , Masculino , Autoinforme , Trastornos del Sueño-Vigilia/complicaciones , Deportes/psicologíaRESUMEN
CONTEXT: Many factors can affect the injury risk and quality of life among high school athletes. Early sport specialization and club sport participation may be components to consider when assessing the injury risk and quality of life. OBJECTIVE: To investigate patient-reported quality-of-life and injury-history measures among adolescent athletes at different sport-specialization levels and to compare these measures between those who did and those who did not report participating in club sports. DESIGN: Cross-sectional study. SETTING: High school athletic facility. PATIENTS OR OTHER PARTICIPANTS: High school student athletes 13 to 18 years of age were recruited and tested during their annual preseason athletic physical examinations. MAIN OUTCOME MEASURE(S): Our primary grouping variables were sport-specialization level (classified as low, moderate, or high) and club sport participation (organized sport outside of traditional school athletics). Our outcome variables were the Patient-Reported Outcome Measurement Information System Pediatric Profile-37 rating, Severity Measure for Depression-Child score, and injury history. RESULTS: A total of 97 individuals participated (mean age = 15.2 ± 1.1 years; 38% female). Relatively similar proportions of individuals reported participating at each level of sport specialization (low = 34%, moderate = 40%, high = 26%). Forty-six (48%) participants stated they participated in club sports. No differences were evident in quality of life (P values = .15-.92 across domains), depression (P = .60), or injury history (P > .70) among the specialization groups. Those who described participating in club sports had a higher proportion of time-loss musculoskeletal injuries (63% versus 29%; P = .002) and of injuries requiring imaging, injection, a cast, a brace, or crutches (72% versus 46%; P = .013) than those who did not. CONCLUSIONS: Although no injury-history differences were found among the sport-specialization groups, a higher proportion of club sport athletes than nonclub sport athletes reported a history of injury. Club sports are generally seen as more competitive, and the higher number of injuries seen in this setting could be related to a higher level of play among club sport athletes.
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Atletas , Traumatismos en Atletas , Depresión , Calidad de Vida , Especialización , Estudiantes , Adolescente , Atletas/psicología , Atletas/estadística & datos numéricos , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Traumatismos en Atletas/psicología , Estudios Transversales , Depresión/etiología , Depresión/fisiopatología , Depresión/prevención & control , Femenino , Humanos , Masculino , Medición de Resultados Informados por el Paciente , Medición de Riesgo , Factores de Riesgo , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVE: To determine the relationship between low back pain (LBP), flexibility, and individual demographic characteristics in competitive adolescent female gymnasts. DESIGN: Cross-sectional observational study. SETTING: Gymnastics facilities in Colorado. PARTICIPANTS: Six- to 18-year-old gymnasts who participate in the USA Gymnastics Women's Artistic Junior Olympic Program levels 3 to 10. INDEPENDENT VARIABLES: Demographic data included height, weight, menstrual status, gymnastics level, and participation hours per week. Flexibility measurements were obtained on the gymnasts. Gymnasts also completed a questionnaire documenting LBP in the past 12 months. Univariable (t test and χ) analyses were used to assess between-group differences; multivariable logistic regression model was used to assess the association between LBP, flexibility, and demographics/injury history. MAIN OUTCOME MEASURES: Low back pain within the past 12 months. RESULTS: Thirty (45%) of 67 gymnasts reported LBP within the past year. Those who reported LBP were older (11.7 vs 13.7 years, P = 0.005), heavier (37.5 vs 43.4 kg, P = 0.049), and participated in gymnastics more often (19.1 vs 22.4 h/wk, P = 0.017). A greater proportion of gymnasts with LBP had experienced menarche compared with those without LBP (47% vs 16%; P = 0.008). On multivariable analysis, gymnasts with LBP were less likely to have left Iliotibial (IT) band tightness compared with those without LBP [adjusted odds ratio (aOR) = 0.186; 95% confidence interval (CI), 0.04-0.82] and more likely to have experienced menarche (aOR = 8.0; 95% CI, 1.2-50.9). CONCLUSIONS: Low back pain is more common in gymnasts who experienced menarche, whereas limited joint flexibility does not seem to be associated with LBP in this population.
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Gimnasia/lesiones , Articulaciones/fisiología , Dolor de la Región Lumbar/fisiopatología , Rango del Movimiento Articular , Adolescente , Factores de Edad , Peso Corporal , Niño , Estudios Transversales , Femenino , Gimnasia/fisiología , Humanos , Dolor de la Región Lumbar/epidemiología , Menarquia , Músculo Esquelético/fisiología , Acondicionamiento Físico Humano/fisiología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To identify clinically significant postural control measures capable of distinguishing the performance of adolescents with concussion from uninjured controls. APPROACH: Fifteen adolescents with concussion (67% female; median age = 16.3 years; tested 8 ± 4 d post-injury) and 31 controls (45% female; median age = 15.2 years) completed a single/dual-task gait evaluation with a smartphone affixed to their lumbar spine, modified balance error scoring system (mBESS), and single/dual-task tandem gait test. Outcome measures were obtained via smartphone (single/dual-task gait speed, cadence, step length), mBESS (double/single/tandem errors), and tandem gait (single/dual-task time). We calculated area under the curve (AUC) values for each measure that demonstrated a significant difference between groups independently, and calculated a comprehensive AUC value for all measures combined. MAIN RESULTS: The concussion group walked significantly slower (mean = 0.89 ± 0.15 versus 1.05 ± 0.15 m s-1; pâ = 0.002) and with significantly fewer steps per minute (median = 103 [interquartile range = 94-108] versus 116 [104-118] steps/minute; pâ = 0.002) than the control group under single-task conditions. They also completed single-task (median = 22.0 [16.6-24.2] versus 14.5 [12.4-15.5] s; pâ < 0.001) and dual-task (median = 30.0 [24.0-35.2] versus 18.6 [16.1-21.7] s; pâ < 0.001) tandem gait tests significantly slower than controls. The AUC value for single-task gait velocity, single-task cadence, single-task tandem gait time, and dual-task tandem gait time indicated an excellent ability to distinguish between concussion and control groups (AUC = 0.91, 95% CI = 0.80-0.99). SIGNIFICANCE: Smartphone-obtained gait measures and tandem gait times allowed for an excellent differentiation between adolescents with concussion versus control participants. This reinforces the need for multimodal approaches to postural control impairment recognition among adolescents with concussion.
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Conmoción Encefálica/fisiopatología , Monitoreo Fisiológico , Equilibrio Postural , Adolescente , Estudios de Casos y Controles , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: To determine the scores of gymnasts with low back pain (LBP) on two functional pain scales: the Micheli Functional Scale (MFS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ). DESIGN: Cross-sectional study. SETTING: Gymnastics facilities. PARTICIPANTS: Female gymnasts aged 7-18 years. MAIN OUTCOME MEASURES: We grouped gymnasts into those having pain affecting gymnastics and those with pain not affecting gymnastics and then compared MFS and ODQ scores for various activities. RESULTS: Eleven of the 29 participants (38%) endorsed LBP during gymnastics and 18 had LBP not affecting gymnastics. There were no demographic differences between the two groups. A significantly greater proportion of gymnasts who had pain during gymnastics reported pain with jumping (Nâ¯=â¯11, 100% vs Nâ¯=â¯8, 44%, pâ¯=â¯0.003) and lifting weights (Nâ¯=â¯4, 36% vs Nâ¯=â¯0, pâ¯=â¯0.016) compared to those not having pain during gymnastics. There were no significant differences between the two groups for pain with spine flexion or extension or for hip flexibility. CONCLUSIONS: Although gymnastics requires extreme flexion and extension of the spine, gymnasts whose pain affects them during gymnastics do not endorse more pain with these movements. Gymnasts with LBP during gymnastics are more likely to have pain with jumping and with lifting weights.